Alopecia X is a form of symmetrical pattern baldness and skin hyperpigmentation seen primarily in Nordic breeds and Toy or Miniature Poodles. While it is purely a cosmetic condition, many owners find it unpleasant to have a progressively balding pet. Treatment protocols for Alopecia X are at best a trial and error approach, since the underlying cause of this disorder is not known. The overall therapeutic goal is to restore the dog’s coat and, hopefully, prevent recurrence of hair loss.
Most hormone-based hair losses look alike. Before treating a dog suspected to have Alopecia X, a veterinarian will try to rule out diseases that mimic Alopecia X, especially Cushing’s disease and hypothyroidism. If Alopecia X is caused by hormonal imbalances as is suspected, then hormone therapies can be helpful. The first step in treatment is to spay or neuter intact dogs. There are many health and behavioral benefits to sterilization in addition to helping manage the symptoms of Alopecia X. Many dogs will re-grow most if not all of their coat after they are spayed or neutered because of the hormonal changes associated with those procedures. Unfortunately, hair re-growth is not always permanent.
If the affected dog has been neutered or spayed and several months pass without its coat returning, the veterinarian may recommend oral melatonin therapy as the next treatment step. Melatonin is a nutritional supplement; it is not regulated by the Federal Drug Administration, and there can be significant differences in the amount or quality of melatonin found in different brands. Melatonin is readily available over-the-counter in tablet form at health food stores and vitamin retail outlets, as well as at some supermarkets. Current research suggests that melatonin should be given to dogs with Alopecia X orally for at least two or three months. About 50% of dogs reportedly show improvement in hair growth within 6-8 weeks. Once hair growth has stabilized, if it does, the dose of melatonin typically is gradually tapered to a once-a-week dose. It is possible that the treatment can eventually be discontinued, although hair loss may recur. A veterinarian is the best person to recommend any treatment option, including the appropriate dose of melatonin for an affected dog. Please note that melatonin can cause drowsiness and sedation in dogs and in people. It also can affect diabetes, which underscores the importance of having a veterinarian rule out all other diseases that may be causing the dog’s hair loss before classifying the cause as Alopecia X.
If alteration and melatonin do not help, there are some other treatment options to consider. These carry additional potentially adverse side effects and should be discussed with a veterinarian so that the possible benefits of improved cosmetic appearance can be weighed against the possible risks of treatment.
Methyltestosterone therapy (one form of hormone therapy) is often the next treatment option. Testosterone therapy should only be implemented after baseline blood testing, and periodic blood work should be done to monitor levels of this hormone if it is given, as it can be toxic to the liver. This treatment can also cause increased aggression in dogs.
Lysodren, also called mitotane or OP’ddd, is another possible treatment. Lysodren is most often used to treat Cushing’s disease (hyperadrenocorticism). Lysodren acts by eroding the outer layers of the adrenal gland, thereby limiting the amount of adrenal hormones made and distributed throughout the body. Lysodren can be helpful in cases of Alopecia X, because the adrenal gland also is responsible for producing sex hormones. Dogs with Alopecia X do not have Cushing’s disease, and they do not have an overabundance of corticosteroids. Lysodren can cause abnormally low circulating corticosteroid levels, creating a steroid deficiency known as “Addison’s disease,” or hypoadrenocorticism. Dogs treated with Lysodren should have regular blood tests to monitor their hormone levels.
Another option involves giving injections of growth hormone, as some authors suggest that Alopecia X may be caused by a deficiency of this hormone. Growth hormone is a genetically engineered product which is difficult to come by commercially but may be available through veterinary or other academic teaching laboratories and institutions. Administration of growth hormone can contribute to diabetes, so the dog’s blood sugar levels must be carefully monitored if this treatment approach is used. Reports suggest that a 6-month course of growth hormone therapy may produce good results for several years in dogs with Alopecia X.
Other treatments that have been tried include administration of prednisone, anipryl, ketoconazole, leuprolide, cimetidine and other medications. Essentially, each of the above treatments is an attempt to re-start the hair follicle growth cycle. Obviously, since the exact cause of Alopecia X is unknown, there is no one treatment approach that will work for every affected dog. In cases where the hair loss is mild, shampoos which contain soothing ingredients can help calm the symptoms. Again, owners should consult with a veterinarian about which, if any, treatment protocols are best in any given case.
Very often, the best treatment for Alopecia X is no treatment at all – which in medical jargon is called “benign neglect”. While the condition may be unsightly, if it is not harming or bothering the dog, then no treatment is medically necessary. Many dogs with Alopecia X live long, happy lives completely unaffected by their hair loss. They develop their own special look, and are adored by their owners for their uniqueness.